Cardiopulmonary resuscitation (CPR) is a critical emergency procedure aimed at preserving brain function and restoring spontaneous blood circulation and breathing in individuals who are in cardiac arrest. The timely and effective administration of CPR can significantly increase the chances of survival and reduce the risk of long-term neurological damage. Despite its importance, awareness and knowledge of CPR among the general public remain variable and often inadequate, particularly in rural and less accessible regions.^1,2

District Chamba, characterized by its mountainous terrain and remote villages, presents unique challenges in terms of accessibility to healthcare facilities and emergency medical services. The geographical and infrastructural constraints make it imperative for the local population to have basic knowledge of life-saving techniques such as CPR. In the event of a cardiac emergency, immediate response by bystanders can be the deciding factor between life and death, given the potential delays in professional medical intervention.^3,4

Previous studies have highlighted significant gaps in CPR knowledge and training among various demographics, with rural areas often lagging behind urban centers. Factors contributing to this disparity include limited access to educational programs, socioeconomic barriers, and a lack of emphasis on first aid training in community health initiatives.^4-7 Understanding the current level of CPR awareness in Chamba is crucial for developing targeted educational campaigns and training programs that can empower residents with the necessary skills to respond effectively in emergency situations.

The importance of CPR training is underscored by global health organizations, which advocate for widespread public education to enhance community resilience and preparedness. In regions like Chamba, where medical facilities may be sparse and travel times to hospitals can be prolonged, the ability of community members to perform CPR can bridge critical gaps in emergency care. Therefore, this study aims to assess the baseline knowledge and awareness of CPR among the general public in Chamba, identifying specific areas of improvement and opportunities for intervention.

By gauging the awareness and knowledge of CPR in this region, we aim to contribute to the broader efforts of improving emergency medical responses and outcomes. The findings of this study will provide valuable insights into the current state of CPR awareness in District Chamba, guiding future public health strategies and educational initiatives. Ultimately, our goal is to enhance the community's ability to respond to cardiac emergencies, thereby improving survival rates and overall public health in the region.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Cardiopulmonary resuscitation (CPR) among general public of District Chamba ,Himachal Pradesh

• Research Approach -Descriptive

• Research Design-  Cross-sectional survey design

• Study area: District Chamba , Himachal Pradesh

• Study duration- between January  2024 to May 2024

• Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Chamba Himachal Pradesh for a minimum of 12 months

• Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Cardiopulmonary resuscitation (CPR), a precise 5% absolute error margin, and a conservative 5% non-response rate. 

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Cardiopulmonary resuscitation (CPR) was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

• Description of Tool- 

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Cardiopulmonary resuscitation (CPR) . One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

• Validity of tool - by the experts in this field

• Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Chamba Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

• Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations- Participants confidentiality and anonymity was maintained. 

The study collected data from 400 participants residing in District Chamba, Himachal Pradesh, providing a comprehensive overview of their socio-demographic characteristics and CPR knowledge levels.

Table 1 presents a detailed overview of the socio-demographic characteristics of the 400 participants in this study, who are residents of District Chamba, Himachal Pradesh. The age distribution reveals that the largest group of respondents falls within the 31-40 years age bracket, accounting for 29.3% of the sample. This is followed by those aged 18-30 years (25.8%), over 50 years (23.3%), and 41-50 years (21.8%). The gender distribution is relatively balanced, with males constituting 54.3% and females 45.8% of the respondents.

Marital status data shows that a majority of the participants are married (53.8%), while 38.3% are single, and 8.0% fall into other categories. In terms of religious affiliation, the Hindu population predominates at 69.5%, followed by Sikhs at 13.0%, Muslims at 10.3%, and other religions at 7.3%. Employment status indicates that more than half of the respondents are employed (52.0%), with students and unemployed individuals making up 25.0% and 23.0% of the sample, respectively. Regarding educational attainment, 44.3% of participants are graduates, 29.5% have completed high school, 13.5% have postgraduate degrees or higher, and 12.8% have an education level below high school.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

Table 2 provides a comprehensive assessment of the respondents' knowledge and awareness of CPR, with each question designed to evaluate specific aspects of CPR procedures. The table lists 20 questions along with the frequency and percentage of correct answers for each. The question "What is the purpose of CPR?" had the highest correct response rate, with 87.8% of participants answering correctly. Conversely, the question "When should you stop CPR?" had the lowest correct response rate, with only 26.0% of respondents providing the correct answer. Other notable areas of high awareness include questions related to the correct compression to breath ratio, hand placement, and the use of an AED, indicating a reasonable level of foundational CPR knowledge among the participants. However, gaps in knowledge were evident in more specific or nuanced areas, such as the correct number of compressions per minute and the depth of chest compressions.

Table 2: Knowledge Regarding CPR (N=400)

Table 3 categorizes the overall CPR knowledge scores of the participants into four distinct levels: Very Good, Good, Fair, and Poor. The scoring was based on the total number of correct answers out of 20, with scores above 80% (16-20 correct answers) categorized as Very Good, scores between 60-79% (12-15 correct answers) as Good, scores between 41-59% (8-11 correct answers) as Fair, and scores below 40% (less than 8 correct answers) as Poor. According to this classification, 22.3% of the participants were categorized as having Very Good knowledge, 27.8% as Good, 30.5% as Fair, and 19.5% as Poor. This distribution highlights that while a significant portion of the population has a reasonable understanding of CPR, there remains a considerable number of individuals with inadequate knowledge, underscoring the need for targeted educational interventions.

            Table 3: Overall CPR Knowledge Score Categories

Table 4 presents the results of the univariate analysis, examining the relationship between socio-demographic variables and CPR knowledge levels. This table shows the frequency and percentage of participants in each knowledge category (Very Good, Good, Fair, Poor) across different socio-demographic groups, along with the p-value indicating the statistical significance of these associations.

For age, the p-value of 0.042 suggests a significant relationship between age and CPR knowledge, with younger age groups (18-30 and 31-40) tending to have higher knowledge levels compared to older age groups. Gender analysis shows a p-value of 0.021, indicating a statistically significant difference in CPR knowledge between males and females, with males generally demonstrating higher knowledge levels. Marital status also shows a significant association (p-value 0.029), with married individuals displaying higher knowledge levels compared to their single and other counterparts.

The p-value for the religion variable is 0.005, signifying a significant relationship, where Hindus, the majority group, tend to have higher CPR knowledge compared to other religious groups. Employment status is highly significant (p-value 0.001), with employed individuals showing greater CPR knowledge compared to unemployed and student groups. Lastly, the education variable has a p-value of 0.049, indicating that higher educational attainment is associated with better CPR knowledge, with graduates and postgraduates displaying superior knowledge compared to those with lower educational levels.

Table 4: Univariate Analysis of Socio-Demographic Variables and CPR Knowledge Level

Overall, these tables collectively provide a comprehensive understanding of the socio-demographic characteristics, CPR knowledge levels, and the significant factors influencing CPR awareness among the residents of District Chamba. This detailed analysis will aid in identifying specific groups that require targeted educational interventions to improve CPR knowledge and preparedness in the community.

The findings from this study highlight significant insights into the awareness and knowledge of cardiopulmonary resuscitation (CPR) among the general public of District Chamba, Himachal Pradesh. By analyzing the socio-demographic variables and their association with CPR knowledge, this study provides a comprehensive understanding of the current state of CPR awareness in a rural and geographically challenging region. These results not only underscore the existing gaps in knowledge but also point towards targeted interventions that can significantly improve emergency response capabilities within the community.

The variability in CPR knowledge observed in this study is consistent with findings from similar research conducted in other rural areas. For instance, a study conducted in rural Maharashtra reported comparable levels of CPR awareness, with significant gaps noted among older age groups and individuals with lower educational attainment . Our study's finding that younger age groups (18-30 and 31-40) tend to have higher CPR knowledge levels aligns with global trends observed in rural settings, where younger individuals often have more access to educational resources and health information .^7-10

The gender disparity in CPR knowledge, with males demonstrating higher knowledge levels than females, is also reflective of broader societal trends. Similar patterns have been documented in studies conducted in both rural and urban settings across India, indicating a need for gender-sensitive educational programs that can address these disparities . The statistically significant association between employment status and CPR knowledge, with employed individuals showing greater awareness, further supports the notion that socio-economic factors play a crucial role in health education and awareness.^11,12

The significant association between marital status and CPR knowledge, with married individuals displaying higher knowledge levels, may be attributed to the increased sense of responsibility and the likelihood of encountering health emergencies within a family setting. This finding is in line with research conducted in other regions, where family dynamics and responsibilities have been shown to influence health awareness and preparedness . The emphasis on family health and safety in married individuals suggests that educational interventions could benefit from being tailored to family units, promoting collective learning and preparedness.^13-15

Religious affiliation also emerged as a significant factor influencing CPR knowledge. Hindus, the majority religious group in the study, exhibited higher CPR knowledge compared to other religious groups. This pattern may be reflective of broader community outreach and educational initiatives that are more accessible to the majority group. Similar findings have been reported in studies from diverse cultural settings, where dominant religious or cultural groups tend to have better access to health education resources . Addressing these disparities requires culturally sensitive approaches that engage all community segments, ensuring equitable access to life-saving information and training.^16,17

The strong association between educational attainment and CPR knowledge, as evidenced by the significant p-value, highlights the critical role of formal education in health awareness. Participants with higher educational levels, such as graduates and postgraduates, demonstrated superior CPR knowledge compared to those with lower educational levels. This finding is consistent with numerous studies that underscore the impact of education on health literacy and the ability to perform emergency procedures . Educational interventions aimed at improving CPR knowledge should, therefore, focus on enhancing health education within school curricula and adult education programs.^18-20

The results of this study have significant implications for public health strategies in District Chamba and similar rural regions. The evident gaps in CPR knowledge among certain demographic groups call for targeted educational campaigns that address these specific needs. For instance, younger age groups and males have shown relatively better CPR knowledge, suggesting that leveraging peer education and social networks within these groups could be an effective strategy. Additionally, tailored programs for women, older adults, and less educated individuals are crucial to bridge the knowledge gap.

Community-based training sessions, possibly integrated with existing health outreach programs, could enhance CPR knowledge across all demographic groups. The use of local languages and culturally relevant materials can further improve the effectiveness of these interventions. Moreover, considering the significant role of marital status and family dynamics in health awareness, family-centered educational initiatives could foster a culture of preparedness within households.

Limitations and Future Research

While this study provides valuable insights, it is important to acknowledge its limitations. The reliance on self-reported data through an online questionnaire may introduce response biases and limit the generalizability of the findings. Future research could benefit from incorporating practical assessments of CPR skills and knowledge to obtain a more accurate measure of preparedness. Additionally, longitudinal studies examining the impact of targeted educational interventions on CPR knowledge and emergency response outcomes would provide deeper insights into the effectiveness of these programs.

In conclusion, this study underscores significant gaps in CPR knowledge among the general public in District Chamba, Himachal Pradesh, highlighting the critical need for targeted educational interventions to enhance emergency response capabilities in this rural region. By identifying specific socio-demographic factors influencing CPR awareness, such as age, gender, marital status, religion, employment status, and educational attainment, the findings provide a foundation for developing tailored public health strategies. These strategies should focus on community-based training sessions, family-centered educational initiatives, and culturally sensitive approaches to ensure equitable access to life-saving information and skills. Ultimately, improving CPR knowledge in District Chamba will bridge critical gaps in emergency care, enhance community resilience, and improve overall public health outcomes.

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